Senate Panel Discusses Importance of EHR Interoperability

Legislators and witnesses emphasized today at a hearing of the Senate Committee on Health, Education, Labor, and Pensions the importance of improving interoperability of Electronic Health Record (EHR) systems and said interoperability improvements will not only save administrative time and money but also will improve the quality of care patients receive.

The Federal government has invested heavily in EHR systems–which many have seen as a silver bullet for improving cost and care. However, those investments may not have panned out as well as legislators were hoping.

“There was a lot of excitement over electronic health records in Washington–many said these records systems would make it easier for doctors and patients to access a patient’s health records and share information with other doctors,” said committee Chairman Lamar Alexander, R-Tenn., at todays’ hearing.

“Since 2011, the Federal government has spent $38 billion requiring doctors and hospitals to install electronic health records systems through the Meaningful Use program in Medicare and Medicaid. Unfortunately, electronic health records systems have ended up being something physicians too often dread, rather than a tool that’s useful,” he said.

Witnesses agreed that EHR systems have not lived up to their initial hype.

“The ACA [Affordable Care Act] imposed numerous new regulatory regimes on providers, including submitting more data (useful to us researchers, but costly to providers and therefore ultimately to patients and taxpayers),” said Robert A. Book, healthcare and economics expert, advisor to the American Action Forum, and senior research director for Libris Research. “In one case, proponents of new regulations claimed they would save money–a requirement for most providers to adopt electronic health records was supposed to reduce duplication of tests and diagnostic procedures by making results available to all of a patient’s providers. The administrative cost of adopting these new systems has been incurred by providers, but there is no evidence of any savings.”

David Cutler, Harvard College professor and Otto Eckstein professor of applied economics, discussed how improving interoperability of EHR would streamline the billing process and reduce the time burden on employees.

“Technologically, there is no reason why electronic medical record systems cannot interface with billing systems or automatically submit information for quality assessment,” he said. “However, there are few incentives for existing firms to make this happen. Providers do not wish to give insurers access to electronic medical records, because they consider them proprietary. Each individual insurer has little incentive to invest in a system that is more conducive to provider systems, since doing so for a single practice involves large costs and little gain. Makers of electronic medical record systems have incentives to keep their systems exclusive, so that it is more difficult for providers to switch from one company to another. Thus, we are in a situation where costs remain high even though everyone recognizes that they could be reduced.”

Cutler suggested that there are both public and private sector solutions. The private sector solution borrows from how credit cards function, and involves using intermediaries to process information between the EHR systems and insurers. For the public sector, he suggested improving regulations.

“In the public sector, standards regarding health information technology could be modified so that select information flow from electronic medical record systems to billing systems is required,” Cutler testified. “Most of the Federal effort devoted to interoperability has focused on increasing access to clinical information by patients and providers. However, much less attention has been devoted to the links between medical records systems and billing systems.”

Matt Eyles, president and CEO of America’s Health Insurance Plans, shared his thoughts on how interoperability allows for better data collection and quality assessment of physicians.

“Physician reporting on quality measures is impeded by the lack of interoperability across electronic health records and the inability of some EHRs to support the retrieval of quality measurement data,” he explained. “To ensure that consumers have meaningful information on quality, it is important to improve the functionality of EHRs to allow quality data to be extracted and reported on a widespread basis. These efforts should be combined with steps to standardize the use of quality measures across public and private payers, and to streamline and reduce the overall number of quality measures.”